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Jeff Goshe, Mark A. Terry, Jennifer Li, Neda Shamie, David L. Davis-Boozer; Correlation Between Patient Age And Visual Outcome In Patients Undergoing Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK). Invest. Ophthalmol. Vis. Sci. 2011;52(14):769.
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To evaluate the correlation between age and post-operative visual acuity in patients with Fuch’s endothelial dystrophy who have undergone Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK).
A retrospective review was performed of 563 eyes of patients aged 50 to 89 at one institution with visually significant Fuch’s endothelial dystrophy with or without cataract. Eyes with other vision-limiting ocular comorbidities were excluded. All eyes received DSAEK surgery with or without cataract surgery using a single operative technique. Outcomes were stratified by patient decade of life. Pre-operative best-corrected visual acuity (BCVA) and pachymetry were recorded and repeated post-operatively at 6 months, 1 year, and yearly thereafter.
Mean pre-operative BCVAs were 20/40, 20/49, 20/56, 20/66 for the groups aged 50-59 (n=96), 60-69 (n=175), 70-79 (n=203), and 80-89 (n=87), respectively. Mean pre-operative corneal thicknesses for the same groups were 674, 669, 686, and 691 microns. Mean vision at two years post-operatively improved in all groups to 20/22, 20/25, 20/27, and 20/33, respectively. Mean corneal thicknesses at two years were 684, 691, 681, and 663 microns. One-way ANOVA testing was significant at all time points with respect to vision and patient age (p < 0.005). Pearson correlation between age and logmar visual acuity increased from 0.269 at 6 months postoperatively to 0.470 at 2 years postoperatively.
All groups experienced improvement in mean BCVA from the pre-operative to the postoperative period. On average, patients aged 80-89 had BCVAs two lines worse than patients aged 50-59 at two years post-operatively. Both ANOVA testing and the Pearson correlation support a direct relationship between patient age and logmar BCVA at all time points, pre- and postoperatively. Possible explanations for worse visual acuities in older patients include more advanced corneal pathology, decreased capacity for blur recognition, or the presence of subclinical visually significant retinal pathology. Similar corneal thicknesses amongst all groups pre- and postoperatively suggest that the discrepancy is not likely due to differences in corneal pathology. Although the exact mechanism may be unclear, our results highlight the importance of controlling for patient age with regard to visual outcomes when comparing patients who have undergone endothelial keratoplasty.
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